Acute respiratory distress syndrome: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
* | *'''Diagnostic criteria''' | ||
#PaO2/FI02 < 200 | |||
#Cardiogenic pulmonary edema ruled out or wedge pressure < 18 | |||
*Imaging | |||
**Diffuse patchy pulmonary infiltrates | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*CHF | *[[CHF]] | ||
*Pneumonia | *[[Pneumonia]] | ||
*PE | *[[PE]] | ||
*Diffuse alveolar hemorrhage | *Diffuse alveolar hemorrhage | ||
* | *Acute lung injury | ||
* | * | ||
==Workup== | ==Workup== | ||
* | *CXR | ||
* | *CBC | ||
* | *Chem 10 | ||
* | *UA | ||
*LFT | |||
*Lipase | |||
*PT/PTT | |||
*Influenza (seasonal) | |||
*Blood cultures | |||
*Lactate | |||
*Consider bedside echo | |||
*Consider ABG/VBG | |||
==Management== | ==Management== | ||
*Treat underlying cause | |||
**Cover for sepsis | |||
***Pneumonia in addition to other identified source | |||
**Tamiflu 75mg BID oral or NGT if influenza season <ref>http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm</ref> | |||
*Ventilator Settings | *Ventilator Settings | ||
**Permissive hypercapnia | |||
**Tidal volume 6-8cc/kg <ref>Brower RG, et al. "Ventilation With Lower Tidal Volumes As Compared With Traditional Tidal Volumes For Acute Lung Injury And The Acute Respiratory Distress Syndrome". The New England Journal of Medicine. 2000. 342(18):1301-1308.</ref> | **Tidal volume 6-8cc/kg <ref>Brower RG, et al. "Ventilation With Lower Tidal Volumes As Compared With Traditional Tidal Volumes For Acute Lung Injury And The Acute Respiratory Distress Syndrome". The New England Journal of Medicine. 2000. 342(18):1301-1308.</ref> | ||
* | ***Limit barotrauma to healthy area of lung | ||
* | ***Increase PEEP to improve oxygenation | ||
* | ****Maintain plateau pressures < 30 | ||
==Disposition== | ==Disposition== | ||
Revision as of 15:57, 26 March 2014
Background
- Non-cardiogenic pulmonary edema
Clinical Features
- Diagnostic criteria
- PaO2/FI02 < 200
- Cardiogenic pulmonary edema ruled out or wedge pressure < 18
- Imaging
- Diffuse patchy pulmonary infiltrates
Differential Diagnosis
Workup
- CXR
- CBC
- Chem 10
- UA
- LFT
- Lipase
- PT/PTT
- Influenza (seasonal)
- Blood cultures
- Lactate
- Consider bedside echo
- Consider ABG/VBG
Management
- Treat underlying cause
- Cover for sepsis
- Pneumonia in addition to other identified source
- Tamiflu 75mg BID oral or NGT if influenza season [1]
- Cover for sepsis
- Ventilator Settings
- Permissive hypercapnia
- Tidal volume 6-8cc/kg [2]
- Limit barotrauma to healthy area of lung
- Increase PEEP to improve oxygenation
- Maintain plateau pressures < 30
Disposition
- Admit to ICU
See Also
Sources
- ↑ http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
- ↑ Brower RG, et al. "Ventilation With Lower Tidal Volumes As Compared With Traditional Tidal Volumes For Acute Lung Injury And The Acute Respiratory Distress Syndrome". The New England Journal of Medicine. 2000. 342(18):1301-1308.